Doctors’ practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study
- Mabunda, Sikhumbuzo A, O’Mahony, Don, Adedayo, Temitope, Adeleke, Olukayode
- Authors: Mabunda, Sikhumbuzo A , O’Mahony, Don , Adedayo, Temitope , Adeleke, Olukayode
- Date: 2021
- Subjects: Physicians Erythrocytes--Transfusion Article
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/7216 , vital:53088 , xlink:href="https://doi.org/10.4102/phcfm.v13i1.2889"
- Description: Background: Unnecessary blood transfusion exposes recipients to potential harms. Aim: The aim of this study was to describe blood transfusion practice and explore doctors’ attitudes towards transfusion. Setting: A hospital providing level 1 and 2 services. Methods: A mixed-methods study design was used. In the cross-sectional descriptive component, a sample was taken from patients transfused over a 2-month period. Blood use was categorised as for medical anaemia or haemorrhage, and appropriate or not. The qualitative component comprised a purposeful sample for focus group and individual semistructured interviews. Results: Of 239 patients sampled, 62% were transfused for medical anaemia and 38% for haemorrhage. In the medical anaemia group, compliance with age-appropriate transfusion thresholds was 69%. In medical anaemia and haemorrhage, 114 (77%) and 85 (93.4%) of recipients had orders for ≥ 2 red blood cell (RBC) units, respectively. In adults ≥ 18 years old with medical anaemia, 47.1% of orders would have resulted in a haemoglobin (Hb) > 8 g/dL. Six doctors participated in focus group and eleven in individual interviews. There was a lack of awareness of institutional transfusion guidelines, disagreement on appropriate RBC transfusion thresholds and comments that more than one RBC unit should always be transfused. Factors informing decisions to transfuse included advice from senior colleagues, relieving symptoms of anaemia and high product costs. Conclusion: Most orders were for two or more units. In medical anaemia, doctors’ compliance with RBC transfusion thresholds was reasonable; however, almost half of the orders would have resulted in overtransfusion. The attitudes of doctors sampled suggest that their transfusion practice is influenced more by institutional values than formal guidelines. Keywords: red blood cell transfusion; doctors’ attitudes; doctors’ practice; transfusion thresholds; overtransfusion; descriptive study; qualitative study.
- Full Text:
- Date Issued: 2021
- Authors: Mabunda, Sikhumbuzo A , O’Mahony, Don , Adedayo, Temitope , Adeleke, Olukayode
- Date: 2021
- Subjects: Physicians Erythrocytes--Transfusion Article
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/7216 , vital:53088 , xlink:href="https://doi.org/10.4102/phcfm.v13i1.2889"
- Description: Background: Unnecessary blood transfusion exposes recipients to potential harms. Aim: The aim of this study was to describe blood transfusion practice and explore doctors’ attitudes towards transfusion. Setting: A hospital providing level 1 and 2 services. Methods: A mixed-methods study design was used. In the cross-sectional descriptive component, a sample was taken from patients transfused over a 2-month period. Blood use was categorised as for medical anaemia or haemorrhage, and appropriate or not. The qualitative component comprised a purposeful sample for focus group and individual semistructured interviews. Results: Of 239 patients sampled, 62% were transfused for medical anaemia and 38% for haemorrhage. In the medical anaemia group, compliance with age-appropriate transfusion thresholds was 69%. In medical anaemia and haemorrhage, 114 (77%) and 85 (93.4%) of recipients had orders for ≥ 2 red blood cell (RBC) units, respectively. In adults ≥ 18 years old with medical anaemia, 47.1% of orders would have resulted in a haemoglobin (Hb) > 8 g/dL. Six doctors participated in focus group and eleven in individual interviews. There was a lack of awareness of institutional transfusion guidelines, disagreement on appropriate RBC transfusion thresholds and comments that more than one RBC unit should always be transfused. Factors informing decisions to transfuse included advice from senior colleagues, relieving symptoms of anaemia and high product costs. Conclusion: Most orders were for two or more units. In medical anaemia, doctors’ compliance with RBC transfusion thresholds was reasonable; however, almost half of the orders would have resulted in overtransfusion. The attitudes of doctors sampled suggest that their transfusion practice is influenced more by institutional values than formal guidelines. Keywords: red blood cell transfusion; doctors’ attitudes; doctors’ practice; transfusion thresholds; overtransfusion; descriptive study; qualitative study.
- Full Text:
- Date Issued: 2021
The association between HIV tri-therapy with the development of Type-2 Diabetes Mellitus in a rural South African district: A case-control study
- Bam, Nokwanda E, Mabunda, Sikhumbuzo A, Ntsaba, Jafta, Apalata, Teke, Monatshila, Sibusisu C, Chitha, Wesile
- Authors: Bam, Nokwanda E , Mabunda, Sikhumbuzo A , Ntsaba, Jafta , Apalata, Teke , Monatshila, Sibusisu C , Chitha, Wesile
- Date: 2020
- Subjects: Type 2 diabetes , AIDS (Disease) , Rural health
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/4008 , vital:43983 , https://doi.org/10.1371/journal.pone.0244067
- Description: Combination antiretroviral drugs(cARVs)prolong patients’ lives but are unfortunately thought to increase complications related to metabolic disorders including type-2 Diabetes Mellitus(DM).We sought to confirm the association of cARVs with type-2DM and ascertain the extent of this association in a rural South African setting. A case-control study of 177 (33.33%) cases with HIV/AIDS and type-2 DM were selected and compared with 354 (66.67%) non-DM HIV/AIDS unmatched controls from a rural district of South Africa’s third most populous province (Eastern Cape). Cases were identified from community health centres using the district health information system, and controls were identified using simple random sampling from the same health facilities. Odds Ratios (OR), together with 95% confidence intervals, were calculated for all the univariable and multivariable logistic analyses. This study found that cARVs significantly increased the occurrence of type-2 DM among HIV patients. Patients on protease inhibitors (PIs) were at least 21 times significantly more likely to be diabetic than those on the fixed dose combination (FDC); those on stavudine (D4T) and zidovudine (AZT) were 2.45 times and 9.44 times respectively more likely to be diabetic than those on FDC. The odds of diabetes increased by more than three-folds for those who had been on antiretroviral drugs for more than 6 years.
- Full Text:
- Date Issued: 2020
- Authors: Bam, Nokwanda E , Mabunda, Sikhumbuzo A , Ntsaba, Jafta , Apalata, Teke , Monatshila, Sibusisu C , Chitha, Wesile
- Date: 2020
- Subjects: Type 2 diabetes , AIDS (Disease) , Rural health
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/4008 , vital:43983 , https://doi.org/10.1371/journal.pone.0244067
- Description: Combination antiretroviral drugs(cARVs)prolong patients’ lives but are unfortunately thought to increase complications related to metabolic disorders including type-2 Diabetes Mellitus(DM).We sought to confirm the association of cARVs with type-2DM and ascertain the extent of this association in a rural South African setting. A case-control study of 177 (33.33%) cases with HIV/AIDS and type-2 DM were selected and compared with 354 (66.67%) non-DM HIV/AIDS unmatched controls from a rural district of South Africa’s third most populous province (Eastern Cape). Cases were identified from community health centres using the district health information system, and controls were identified using simple random sampling from the same health facilities. Odds Ratios (OR), together with 95% confidence intervals, were calculated for all the univariable and multivariable logistic analyses. This study found that cARVs significantly increased the occurrence of type-2 DM among HIV patients. Patients on protease inhibitors (PIs) were at least 21 times significantly more likely to be diabetic than those on the fixed dose combination (FDC); those on stavudine (D4T) and zidovudine (AZT) were 2.45 times and 9.44 times respectively more likely to be diabetic than those on FDC. The odds of diabetes increased by more than three-folds for those who had been on antiretroviral drugs for more than 6 years.
- Full Text:
- Date Issued: 2020
The effect of the Xpert MTB/RIF test on the time to MDR-TB treatment initiation in a rural setting: a cohort study in South Africa’s Eastern Cape Province
- Iruedo, Joshua, O’Mahony , Don, Mabunda, Sikhumbuzo A, Wright, Graham, Cawe , Busisiwe
- Authors: Iruedo, Joshua , O’Mahony , Don , Mabunda, Sikhumbuzo A , Wright, Graham , Cawe , Busisiwe
- Date: 2017
- Subjects: South Africa Multidrug-resistant tuberculosis Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6098 , vital:45115 , https://DOI10.1186/s12879-017-2200-8
- Description: Background: There are significant delays in initiation of multidrug-resistant tuberculosis (MDR –TB) treatment. The Xpert MTB/RIF test has been shown to reduce the time to diagnosis and treatment of MDR-TB predominantly in urban centres. This study describes the time to treatment of MDR-TB and the effect of Xpert MTB/RIF on time to treatment in a deprived rural area in South Africa. Methods: This was a retrospective cohort study analysing the medical records of patients diagnosed with MDR-TB in King Sabata Dalindyebo Sub-District between 2009 and 2014. Numerical data were reported using the Kruskal-Wallis and Wilcoxon sum rank tests and categorical data compared using the two-sample test of proportions. Results: Of the 342 patients with MDR-TB identified, 285 were eligible for analysis, of whom 145 (61.4%) were HIV positive. The median time from sputum collection to MDR-TB diagnosis was 27 days (IQR: 2–45) and differed significantly between diagnostic modalities: Xpert MTB/RIF, 1 day (IQR: 1–4; n = 114: p less 0.0001); Line Probe Assay 12 days (IQR: 8–21; n = 28; p less 0.0001); and culture/phenotypic drug sensitivity testing 45 days (IQR: 39–59; n = 143: p less 0.0001). The time from diagnosis to treatment initiation was 14 days (IQR: 8–27) and did not differ significantly between diagnostic modality. The median time from sputum collection to treatment initiation was 49 days (IQR: 20–69) but differed significantly between diagnostic modalities: Xpert MTB/RIF, 18 days (IQR: 11–27; n = 114; p less 0.0001); Line Probe Assay 29 days (IQR: 14.5–53; n = 28; p les 0.0001); and culture/phenotypic drug sensitivity, 64 days (IQR: 50–103; n = 143: P less 0.0001). Age, sex and HIV status did not influence the time intervals. Conclusions: Xpert MTB/RIF significantly reduced the time to MDR-TB treatment in a deprived rural setting as a result of a reduced time to diagnosis. However, the national target of five days was not achieved. Further research is needed to explore and address programmatic and patient-related challenges contributing to delayed treatment initiation. Keywords: Xpert MTB/RIF, MDR-TB, Rural, Time-to-treatment, Cohort study
- Full Text:
- Date Issued: 2017
- Authors: Iruedo, Joshua , O’Mahony , Don , Mabunda, Sikhumbuzo A , Wright, Graham , Cawe , Busisiwe
- Date: 2017
- Subjects: South Africa Multidrug-resistant tuberculosis Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6098 , vital:45115 , https://DOI10.1186/s12879-017-2200-8
- Description: Background: There are significant delays in initiation of multidrug-resistant tuberculosis (MDR –TB) treatment. The Xpert MTB/RIF test has been shown to reduce the time to diagnosis and treatment of MDR-TB predominantly in urban centres. This study describes the time to treatment of MDR-TB and the effect of Xpert MTB/RIF on time to treatment in a deprived rural area in South Africa. Methods: This was a retrospective cohort study analysing the medical records of patients diagnosed with MDR-TB in King Sabata Dalindyebo Sub-District between 2009 and 2014. Numerical data were reported using the Kruskal-Wallis and Wilcoxon sum rank tests and categorical data compared using the two-sample test of proportions. Results: Of the 342 patients with MDR-TB identified, 285 were eligible for analysis, of whom 145 (61.4%) were HIV positive. The median time from sputum collection to MDR-TB diagnosis was 27 days (IQR: 2–45) and differed significantly between diagnostic modalities: Xpert MTB/RIF, 1 day (IQR: 1–4; n = 114: p less 0.0001); Line Probe Assay 12 days (IQR: 8–21; n = 28; p less 0.0001); and culture/phenotypic drug sensitivity testing 45 days (IQR: 39–59; n = 143: p less 0.0001). The time from diagnosis to treatment initiation was 14 days (IQR: 8–27) and did not differ significantly between diagnostic modality. The median time from sputum collection to treatment initiation was 49 days (IQR: 20–69) but differed significantly between diagnostic modalities: Xpert MTB/RIF, 18 days (IQR: 11–27; n = 114; p less 0.0001); Line Probe Assay 29 days (IQR: 14.5–53; n = 28; p les 0.0001); and culture/phenotypic drug sensitivity, 64 days (IQR: 50–103; n = 143: P less 0.0001). Age, sex and HIV status did not influence the time intervals. Conclusions: Xpert MTB/RIF significantly reduced the time to MDR-TB treatment in a deprived rural setting as a result of a reduced time to diagnosis. However, the national target of five days was not achieved. Further research is needed to explore and address programmatic and patient-related challenges contributing to delayed treatment initiation. Keywords: Xpert MTB/RIF, MDR-TB, Rural, Time-to-treatment, Cohort study
- Full Text:
- Date Issued: 2017
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